Borderline Personality Disorder Symptom
Impulsivity is the tendency to act on impulse -- that is, without forethought about the appropriateness or consequences of the action. Impulsivity can be manifested in an action or in interrupting a discussion, blurting out answers, or the inability to wait one's turn at an activity. Impulsivity is often accompanied by symptoms such as restlessness, hyperactivity, inattention, problems doing quiet activities, problems with executive function, talking excessively, and fidgeting.
What is borderline personality disorder (BPD)?
Borderline personality disorder (BPD) is a mental illness that is part of the group of mental illnesses called personality disorders. Like other personality disorders, it is characterized by a consistent pattern of thinking, feeling, and interacting with others and with the world that tends to result in significant problems for the sufferer. Specifically, BPD is associated with a pattern of unstable ways of seeing oneself, feeling, behaving, and relating to other people that markedly interferes with the individual's ability to function. Also, as with other personality disorders, the person is usually an adolescent or adult before they can be assessed as meeting full symptom criteria for BPD.
Historically, BPD has been thought to be a set of symptoms that includes both mood problems (neuroses) and distortions of reality (psychosis) and therefore was thought to be on the borderline between mood problems and schizophrenia. However, it is now understood that while the symptoms of BPD may straddle those symptom complexes, this illness is more closely related to other personality disorders in terms of how it may develop and occur within families. BPD is now understood to occur equally in men and women in the general population, while mostly in women in groups of people who are receiving mental health treatment (clinical populations). The frequency with which this disorder occurs is also thought to be considerably higher than previously thought, affecting nearly 6% of adults over the course of a lifetime.
What other disorders often occur with BPD?
Men with BPD are more likely to also have a substance-related disorder and women with this illness are more likely to suffer from an eating disorder. In adolescents, BPD tends to co-occur with more anxious and peculiar personality disorders like schizotypal and passive aggressive personality disorder, respectively. Adults who have antisocial personality disorder, also colloquially called sociopaths, may be more likely to also have BPD. Interestingly, even people who have some symptoms (traits) of BPD but do not meet full diagnostic criteria for the illness can have traits of both BPD and narcissistic personality disorder.
While there has been some controversy as to whether or not BPD is truly its own disorder or a variation of bipolar disorder, research supports the theory that BPD, like virtually every medical or other mental health disorder, can present in nearly as many unique and complex ways as there are people who have it. In other words, some individuals with BPD will have that disorder alone, while others will have it in combination with bipolar or another mental disorder. Still others will appear to have BPD but really qualify for the diagnosis of bipolar disorder and vice versa.
Obsessive compulsive disorder (OCD) can also co-occur with BPD. It is thought to be particularly true of people who have OCD and bipolar disorder. BPD is not recognized worldwide. It is most closely diagnosed as emotionally unstable personality disorder in the International Classification of Disease, or ICD-10. Although countries like China and India recognize mental disorders that have some symptoms in common with BPD, its existence is not formally recognized.
What causes borderline personality disorder?
Although there is no specific cause for BPD, it is understood to be the result of a combination of biological predispositions, ways of understanding the world, and social stressors (biopsychosocial model). Biologically, people with BPD are more likely to have abnormalities in the size of the hippocampus, in the size and functioning of the amygdala, and in the functioning of the frontal lobes, which are the areas of the brain that are understood to regulate emotions and integrate thoughts with emotions. Although some research indicates that people with BPD seem to have areas of the brain that are more and less active compared to individuals who do not have the disorder, other research contradicts that.
While BPD is not thought to be genetic, it can somewhat run in families. Psychologically, BPD seems to make a person more vulnerable to having unstable moods, particularly impulsive aggression. Socially, this disorder predisposes sufferers to developing insecurity, to be more likely to excessively expect to be criticized or rejected and negatively personalize disinterest or inattention from other people. These tendencies result in BPD sufferers having significantly impaired social relationships. In addition to these problems, people with BPD are more likely to have suffered from trauma in the form of childhood abuse or neglectful parenting.
What are the risk factors for borderline personality disorder?
Adults who come from families of origin where divorce, neglect, sexual abuse, substance abuse, or death occurred are at higher risk of developing BPD. In children, the risk for developing this disorder appears to increase when they have a learning problem or certain temperaments. Adolescents who develop alcohol abuse or addiction are also apparently at higher risk of developing BPD compared to those who do not.
Quick GuideWhat's Your Biggest Fear? Phobias
What is the treatment for borderline personality disorder?
Clinical trials have determined that different forms of psychotherapy have been found to effectively treat BPD. Dialectical behavior therapy (DBT) is a method of psychotherapy in which the therapist specifically addresses four areas that tend to be particularly problematic for individuals with BPD: self-image, impulsive behaviors, mood instability, and problems in relating to others. To address those areas, treatment with DBT tries to build four major behavioral skill areas: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
Another psychotherapy approach that is specifically designed to treat BPD is mentalization-based treatment. Based on understanding of how, when, and the quality of attachments people form, its goal is to improve the person's ability to understand his or her own and others' mental states. This treatment approach uses weekly individual therapy and group sessions over 18 months.
Talk therapy that focuses on helping the person understand how their thoughts and behaviors affect each other (cognitive behavioral therapy or CBT) has also been found to be effective treatment for BPD. Schema therapy, also called schema-focused cognitive therapy, is based on a theory that many maladaptive ways of thinking (cognitions) are the result of past experiences. This approach to psychotherapy has also been found to alleviate the symptoms of BPD.
Other psychotherapy approaches that have been used to address BPD include interpersonal psychotherapy (IPT) and psychoanalytic therapy. IPT is a type of psychotherapy that addresses how the person's symptoms are related to the problems that person has in relating to others. Psychoanalytic therapy, which seeks to help the individual understand and better manage his or her ways of defending against negative emotions, has been found to be effective in addressing BPD, especially when the therapist is more active or vocal than in traditional psychoanalytic treatment and when this approach is used in the context of current rather than past relationships. Considered a form of psychodynamic psychotherapy, transference-focused psychotherapy involves the therapist clarifying, confronting, and interpreting the evolving reactions that the person with BPD has toward the therapist that are thought to be a repetition of the person's previous relationships (transference). Some BPD sufferers are found to benefit from this form of therapy, as well.
The use of psychiatric medications, like antidepressants (for example, fluoxetine [Prozac], sertraline [Zoloft], paroxetine [Paxil], citalopram [Celexa], escitalopram [Lexapro], vortioxetine (Trintellix) venlafaxine [Effexor], desvenlafaxine (Pristiq), duloxetine [Cymbalta], vilazodone (Viibryd) or trazodone [Desyrel]), mood stabilizers (for example, divalproex sodium [Depakote], carbamazepine [Tegretol], or lamotrigine [Lamictal]), or antipsychotics (for example, olanzapine [Zyprexa], risperidone [Risperdal], aripiprazole [Abilify], paliperidone [Invega], iloperidone [Fanapt], asenapine [Saphris]), lurasidone (Latuda), or brexpiprazole (Rexulti) may be useful in addressing some of the symptoms of BPD but do not manage the illness in its entirety. On a positive note, some women who suffer from both BPD and bipolar disorder may experience a decrease in how irritable and angry they feel, as well as a decrease in how often and severely they become aggressive when treated with a mood-stabilizer medication like Depakote. On the other hand, the use of medications in the treatment of individuals with BPD may sometimes cause more harm than good. For example, while people with BPD may experience suicidal behaviors no more often than other individuals with a severe mental illness, they often receive more medications and therefore suffer from more side effects. Also, given how frequently many sufferers of BPD experience suicidal feelings, great care is taken to avoid the medications that can be dangerous if taken in overdose.
Partial hospitalization is an intervention that involves the individual with mental illness being in a hospital-like treatment center during the day but returning home each evening. In addition to providing a safe environment, support and frequent monitoring by mental health professionals, partial hospitalization programs allow for more frequent mental health interventions like professional assessments, psychotherapy, medication treatment, as well as development of a treatment plan for after discharge from the facility. While funding a long-term stay in a partial hospitalization facility may be difficult, studies show that when it is provided using a psychoanalytic or psychodynamic approach, it may help the person with BPD enjoy a decrease in the severity of general discontent, anxiety, depression, and inability to feel pleasure, as well as decreasing the frequency of suicide attempts and full hospitalizations. This treatment may also help the individual develop improved relationships with others such that the BPD sufferer may be less likely to engage in social isolation. Contrary to earlier beliefs, BPD has been found to significantly improve in response to treatment with appropriate inpatient hospitalization. Family members of individuals with BPD might benefit from participation in a support group.
What are borderline personality disorder complications?
The presence of BPD often worsens the course of another mental condition with which it occurs. For example, it tends to change the symptoms of posttraumatic stress disorder and to worsen depression.
Individuals with BPD are at risk for self-destructive behaviors like self-mutilation, as well as for attempting or completing suicide. While cutting and other forms of self-harm, as well as suicidal behaviors seem to be associated with alleviating negative feelings, it is thought that self-mutilating behaviors are more an expression of anger, punishing oneself, distracting oneself, and maladaptively eliciting more normal feelings. In contrast, suicide attempts are thought to be more often associated with feeling survivors will be better off for their death. People who engage in self-mutilation are more likely to commit suicide compared to those who do not self-mutilate.
Although most individuals with a mental disorder do not engage in violent behavior, those who suffer from BPD have a somewhat increased risk for such behaviors. That risk is also increased for individuals who suffer from narcissism, antisocial personality disorder, have a history of previously engaging in violent behavior, frequent use of sedative medications, or experience several changes in their psychiatric medications in general.
Complications of BPD also often involve families of the person with the disorder. For example, a parent with BPD is vulnerable to having depressive symptoms in their children.
What is the prognosis of people with borderline personality disorder?
Improvement in any personality disorder is not the same as being cured, in that while the symptoms of BPD do tend to diminish (remit) with time, some often remain. Therefore, full recovery can be difficult to achieve. But how well or poorly people with BPD progress over time seems to be influenced by how severe the disorder is at the time that treatment starts, the state of the individual's current personal relationships, whether or not the sufferer has a history of being abused as a child, as well as whether or not the person receives appropriate treatment and how long it takes for that to occur. Simultaneously suffering from depression, other emotional problems, or a low level of conscientiousness have been found to be associated with a greater likelihood of the symptoms of BPD returning (relapsing). Conversely, having steady employment or school status once symptoms of BPD subside (remit) tends to protect BPD sufferers from experiencing a future relapse.
People with BPD are at higher risk for having long-term substance abuse. Other complications that are associated with this personality disorder include unemployment, social isolation, reckless driving, legal problems, as well as suicide attempts and completion.
Is it possible to prevent borderline personality disorder?
Societal interventions like prevention of child abuse, domestic violence, and substance abuse in families can help decrease the occurrence of a number of very different mental health problems. In contrast, specific prevention of BPD tends to focus on recognizing traits of the disorder as early as possible, followed by intensive treatment.
Subscribe to MedicineNet's Depression Newsletter
Medically Reviewed on 10/27/2017
Abela, J.R.Z., S.A. Skitch, R.P. Auerbach, and B.A. Adams. "The Impact of Parental Borderline Personality Disorder on Vulnerability to Depression in Children of Affectively Ill Parents." Journal of Personality Disorders 19.1 (2005): 68-83.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, Virginia: American Psychiatric Association, 2013.
Axelrod, S.R., Morgan, C.A., Southwick, S.M. Symptoms of posttraumatic stress
disorder and borderline personality disorder in veterans of operation desert
storm. American Journal of Psychiatry 162 Feb. 2005: 270-275.
Bateman, A., Fonagy, P. Treatment of borderline personality disorder with psychoanalytically
oriented partial hospitalization: An 18-month follow-up. Focus 4 Spring 2006:
Becker, D.F., Grilo, C.M., Edell, W.E., et al. Comorbidity of borderline personality
disorder with other personality disorders in hospitalized adolescents and
adults. American Journal of Psychiatry 157 Dec. 2000: 2011-2016.
Biskin, R.S., and J. Paris. "Management of borderline personality disorder." Canadian Medical Association Journal 184.17 November 2012: 1897-1902.
Biskin, R.S., et al. "Outcomes in women diagnosed with borderline personality disorder in adolescence." Journal of the Canadian Academy of Child and Adolescent Psychiatry 20.3 August 2011: 168-174.
Comtois, K.A., Linehan, M.M. Reasons for suicide attempts and nonsuicidal self-injury
in women with borderline personality disorder. Journal of Abnormal Psychology
111.1 Feb. 2002: 198-202.
Brunton, J.N., Lacey, J.H., Waller, G.D. Narcissism and
eating characteristics in young nonclinical women. The Journal of Nervous and
Mental Disease 193.2 Feb. 2005: 140-143.
Chanen, A.M., L.K. McCutcheon, M. Jovev, et al. "Prevention and early intervention for borderline personality disorder." Medical Journal of Australia 187.7 (2007): 18.
Clarkin, J.F., P.A. Foelsch, K.N. Levy, et al. "The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change." Journal of Personality Disorders 15.6 (2001): 487-495.
Dimaggio, G. "Awareness of maladaptive interpersonal schemas as a core element of change in psychotherapy for personality disorders." Journal of Psychotherapy Integration 25.1 Mar. 2015: 39-44.
Dolan, B., Warren, F., Norton, K.
Change in borderline symptoms one year after therapeutic community treatment for
severe personality disorder. The British Journal of Psychiatry 171 (1997):
Farrell, J.M., I.A. Shaw, and M.A. Webber. "A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial." Journal of Behavior Therapy and Experimental Psychiatry 40.2 June 2009: 317-328.
Frankenburg, F.R., Zanarini, M.C. Divalproex sodium treatment of women with
borderline personality disorder and bipolar II disorder: a double-blind
placebo-controlled pilot study. Journal of Clinical Psychiatry 63.5 May 2002:
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., et al. Outpatient psychotherapy
for borderline personality disorder: randomized trial of schema-focused therapy
vs. transference-focused psychotherapy. Archives of General Psychiatry 63 (2006:
Grant, B.F., Chou, S.P., Goldstein, R.B., et al. Prevalence, correlates,
disability and comorbidity of DSM-IV borderline personality disorder: results
from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.
Journal of Clinical Psychiatry 69.4 Apr. 2008: 533-545.
Gunderson, J.G., Daversa,
M.T., Grilo, C.M., McGlashan, T.H., et al. Predictors of 2-year outcome for patients
with borderline personality disorder. American Journal of Psychiatry 163 May 2006: 822-826.
Harman, M.J. Children at-risk for borderline personality disorder. Journal of
Contemporary Psychotherapy 34.3 Sept. 2004: 279-290.
Jimenez-Murcia, S., et al. "Obsessive-compulsive and eating disorders: comparison of clinical and personality features." Psychiatry Clinical Neuroscience 61.4 August 2007: 385-391.
Kreger, R. "Finding professional help for borderline personality disorder." Psychology Today May 2010.
Levy, K.N., K.B. Meehan, K.M. Kelly, et al. "Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder." Journal of Consulting and Clinical Psychology 74.6 (2006): 1027-1040.
Lis, E., Greenfield, B., Henry, M., Guile, J.M., Dougherty, G. Neuroimaging and
genetics of borderline personality disorder: a review. Journal of Psychiatry and
Neuroscience 32.3 May 2007: 162-173.
Maina, G., U. Albert, E. Pessina, and F. Bogetto. "Bipolar obsessive-compulsive disorder and personality disorders." Bipolar Disorder 9.7 November 2007: 722-729.
Makela, E.H., Moeller, K.E., Fullen, J.E., Gunel,
E. Medication utilization patterns and methods of suicidality in borderline
personality disorder. The Annals of Pharmacotherapy 40.1 (2006): 49-52.
A.L., Wyman, S.E., Huppert, J.D., et al. Analysis of behavioral skills utilized by
suicidal adolescents receiving dialectical behavior therapy. Cognitive and
Behavioral Practice 7.2 (2000): 183-187.
Nath, S., Patra, D.K., Biswas, S., Mallick, A.K.,
Bandyopadhyay, G.K., Ghosh, S. Comparative study of personality disorder associated
with deliberate self harm in two different age groups (15-24 years and 45-74
years). Indian J Psychiatry 50 (2008): 177-80.
Oldham, J.M. Borderline personality
disorder: an overview. Psychiatric Times 21.8 July 2004.
Oldham, J.M. Borderline
personality disorder comes of age. American Journal of Psychiatry 166 May 2009: 509-511.
Oldham, J.M. "Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder." APA Practice Guidelines Mar. 2005.
Oumaya, M., Friedman, S., Pham, A., et al. Borderline personality disorder,
self-mutilation and suicide: literature review. Encephale 34.5 Oct 2008:
Paris, J. "The outcome of borderline personality disorder: Good for most but not all patients."
American Journal of Psychiatry 169.5 January 2012: 445-446.
Quigley, B.D. Diagnostic Relapse in Borderline Personality Disorder: risk
and protective factors. 2003 August Doctoral dissertation, Texas A & M
Rohde, P., Lewinsohn, P.M., Kahler,
C.W., Seeley, J.R., Brown, R.A. Natural course of alcohol use disorders from
adolescence to young adulthood. Psychiatry 40.1 Jan. 2001: 83-90.
Sansone, R.A., and M.W. Wiederman. "Driving recklessly: relationships with borderline personality symptomatology." Primary Care Companion for CNS Disorders 15.1 (2013).
A.E., Reza, H. Risk factors and correlates of violence among acutely ill adult
psychiatric inpatients. Psychiatric Services 52 Jan. 2001: 75-80.
Lynch, K.G., Kelly, T.M., Malone, K.M., Mann, J.J. Characteristics of suicide attempts of
patients with major depressive episode and borderline personality disorder: a
comparative study. American Journal of Psychiatry 157 Apr. 2000: 601-608.
Stone, M.H. Relationship of borderline personality disorder and bipolar disorder.
American Journal of Psychiatry 163 July 2006: 1126-1128.
van Asselt, A.D.I.,
Dirksen, C.D., Arntz, A., et al. Out-patient psychotherapy for borderline personality
disorder: cost-effectiveness of schema-focused therapy v. transference-focused
psychotherapy. The British Journal of Psychiatry 192 (2008): 450-457.
Recent developments in borderline personality disorder. Advances in Psychiatric
Treatment 6 (2000): 211-217.
World Health Organization. Tenth revision of the
international classification of disease, chapter V(F): mental and behavior
disorders. Diagnosis criteria for research. Geneva: World Health Organization;
Zanarini, M.C., Frankenburg, F.R., Dubo, E.D., et al. Axis I comorbidity
of borderline personality disorder. American Journal of Psychiatry 155.12 Dec. 1998: 1733-1739.
Zanarini, M.C., Williams, A.A., Lewis, R.E., et al. Reported
pathological childhood experiences associated with the development of borderline
personality disorder. American Journal of Psychiatry 154 (1997): 1101-1106.
J., Leung, F. Should borderline personality disorder be included in the fourth
edition of the Chinese classification of mental disorders? Chinese Medical
Journal 120.1 (2007): 77-82.